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EHO LOG NUM6ER <br /> SAN JOAQUIN COUNTY <br /> QPM LO06 <br /> LWIRONMENTAL B[EALTH DEPARTMENT <br /> �r� 304 Fast Weber Avenue.3`d Floor,Stockton,CA 95202-2708 <br /> ENVIRONMENT 11EAL61T(apltone:(209)468-3420 Fax:(209)464.0138 Web:www.Sjgov.org/ehG'' r2 <br /> 7 <br /> M(0 <br /> to- <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION ��_// <br /> APP6ICANT: l A r' o I 1 u•d Q r BUSINESSIAGENCY: CZS 1= �""4 <br /> ADDRESS' 7Tll S.- Ray1w,oc..IG SJ- kSDP I T� �ofI-D <br /> PHONE(1): 7 0 -9 Jr0-5D`t�3 PHONE(2): FACSIMILE: L ''788^`)�oZS <br /> TENTATIVE'APPOINTMENT DATE: _T'LMr^S dnPr. )� Time: <br /> (Please allow 10 business days from date of appllcatl n submfuai-•Tentsave Only-must be conflmled) <br /> ®'CHECK SOX TO EXPEDITE REQUEST-693.00 FEE(CASH OR CHECK ONLY).REQUEST PROCESSED INS BUSINESS DAYS <br /> SIGNATURI=OF APPLICANT ( Q^a� —DATE <br /> UNIT DISTRIBUTION EI unit 1 ❑ Unit 2 QUnit 3 0Unit 4 Ounit 5 Q Unit to other(elecUonidlistshnaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Sireetfl QStreet Name city <br /> 2. (tl <br /> 3. <br /> 4. 1 <br /> 5- <br /> 6. <br /> 9. <br /> 70. <br /> Specific bate Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> WUNDEAGROUND TANK(USTI CLEANUP SITE(LOP) O HOUSING AeATEMeNT O SfILID WAS re FACUTYNEHICLE <br /> W OTHER CLEANUP SITE(Nom-LOP) M FOOD FACILITY d WASTE nRE <br /> LYUNDEAGROUND TANK(MONITOR OtEMOVAL) C DOG KENNEL I7 DAIRY <br /> ErHAZARDOU9 WASTE GENERATOR 13C14CKEN RANCH O WASTEWATER TREATMENT PLANT <br /> O TIEREDPERMITTEDFACtLITY GRIOTEUHOTeL O PUMPER TRUCIUYARDICHEM TOILETS <br /> ❑TATTOOIEODY PIERCING LA POOLISPA 0 LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY Cl OTHER(PLEASE SPECIFY) - <br /> WELLANDSEPTICPERN(n RECDRDS ARE AVAILAaLE FOR RVAEW- MONDAY•FMDAY 8:08 AM5:OOPM - EXCLUDING HOLIDAYS, <br /> 1. List up to ten addresses in the space above, Select the type($)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected- Fax to(209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately ten(10) days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly, <br /> 3. A file that Is actively being worked on by EHD staff may not be Immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the <br /> applicant, Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> END d 1� <br /> IMM <br /> E0/Z0 39Vd 9NIlif1S1,100 E3 GZL6BBLEOE LS:£S 900Z/L0/V0 <br />